Medicare Advantage vs Medigap: Understanding Your Options

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Sixty percent of retirees left the workforce earlier than they had planned due to health concerns, the state of the economy, and other factors beyond their control. When these types of situations happen, seniors can find themselves making important decisions about their futures sooner than expected. 

One of these key decisions is choosing between Medicare Advantage vs Medigap health insurance plans. If this decision is in your future, here’s a look at the major similarities and differences between the two to help you start planning now. Take a look. 

Medicare Advantage vs Medigap: What’s the Same

Both Medicare Advantage Plans and Medigap Plans serve the same primary purpose. They provide coverage for things that traditional Medicare alone does not cover. In most cases, this includes important services such as: 

  • Dental care
  • Vision care 
  • Foot care
  • Hearing care

Both types of plans are sold and administered by private insurance companies authorized to do so by Medicare. Medicare also requires both types of plans to meet minimum coverage standards.

That is where the similarities end. 

Medicare Advantage Plan vs Medigap Insurance: The Key Differences

When exploring Medicare Advantage Plans vs Medigap insurance, important differences quickly come to light. 

Medicare Advantage Plans:

  • Bring all of the coverage provided by Medicare Parts A, B, and D together under a single easy-to-use plan
  • Do not cover some common costs such as skilled nursing facility care and care received while traveling outside the United States
  • Are not standardized, which can make them difficult to compare to one another
  • Include out-of-pocket expense limits

Medigap Insurance Plans:

  • Do not kick in for covered services until you and Medicare have paid your full share
  • Kick in to pay for a portion of services covered by the Medigap plan but not Medicare
  • Cover some costs not covered by Medicare such as emergency care outside the United States and long-term care facilities
  • May cover some of your Medicare Part A and B copays
  • Are standardized, making it easy to compare costs and value
  • Only cover one person, meaning spouses must each purchase independent policies 
  • May or may not include out-of-pocket expense limits

As these lists show, there are substantial differences in what you can expect from each type of plan.

Choosing a Medicare Advantage Plan vs a Medigap Plan

Medicare beneficiaries may not hold both types of plans at once. They can switch between them during enrollment periods but must choose one or the other to enroll in at any given time.  

When choosing between plans, it is helpful to consider:

  • Your budget
  • Travel plans
  • Realistic expectations of your long-term health and care needs
  • The importance of out-of-pocket expense limits to your situation

Before enrolling, beneficiaries should consult in-depth explanations and guides on their options, such as those by MedicareWire.com. Taking the time to do so can reveal important caveats and ensure you make the right choice. 

More on Health

Choosing between Medicare Advantage vs Medigap Plans is an important decision and not to be taken lightly. Stay up to date on other key health concerns and decisions by checking out our health section